Application Request

Please enter the following information to access the Licensing Application for potential licensees. Please note this form is for application tracking purposes only and is not the actual licensing application. Once you complete the information below and click submit, you will have access to a new screen with the complete licensing application that must be submitted to CLC for institution approval.

Prior to completing the form and downloading the application, please download Adobe Reader XI.  This free software is available at www.adobe.com and allows the writable PDF form to be completed and saved rather than having to print and manually complete the form.

 
 
 
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* - Required
 
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